Corrections?

[Tom1982]

After our daughter has breakfast, we would typically check her levels and hour or hour and half after. This morning for example, she was 14.7 an hour and a half after breakfast. Does that suggest I carb counted the wrong dose or, is this normal? Also the meter wants to correct with an addition unit of insulin. Would you go for that or just wait until her level naturally falls?

 

[rebrascora]

That spike usually indicates that you didn't prebolus far enough in advance and after just an hour or so I would wait to see what happens. I need a really long prebolus time on a morning so I inject my breakfast insulin before I get out of bed and then get washed and dressed and make my breakfast and be drinking my coffee before my insulin has started to kick in and I eat breakfast. It is usually 45mins for me between injecting and eating at breakfast to prevent a spike. That is extreme and many people would hypo in that time but if you are only giving the insulin 15 mins to get working before breakfast then experiment with increasing that by a few mins each day until you see the spike reducing in height and find the right timing for your daughter.
Libre or other CGM is brilliant for allowing you to see when the insulin is starting to work by the trend arrows and helping you to time your breakfast to prevent such big spikes.

 

[Tom1982]

That spike usually indicates that you didn't prebolus far enough in advance and after just an hour or so I would wait to see what happens. I need a really long prebolus time on a morning so I inject my breakfast insulin before I get out of bed and then get washed and dressed and make my breakfast and be drinking my coffee before my insulin has started to kick in and I eat breakfast. It is usually 45mins for me between injecting and eating at breakfast to prevent a spike. That is extreme and many people would hypo in that time but if you are only giving the insulin 15 mins to get working before breakfast then experiment with increasing that by a few mins each day until you see the spike reducing in height and find the right timing for your daughter.
Libre or other CGM is brilliant for allowing you to see when the insulin is starting to work by the trend arrows and helping you to time your breakfast to prevent such big spikes.

Great call. I do tend to rush that a bit. Might try 20 minutes and see how we go

 

[SB2015]

some insulins will take a bout four hours to complete their job so within 1 1/2 hours after a meal there is still some active insulin there. To reduce the spike I would agree with @rebrascora about timing the bolus. I don’t always make time to do this effectively and it took a bit of experimentation to work out what suits me. I find the timing of boluses changes through the day with more time needed in the morning than later in the day. Do change things gradually.

 

[Lily123]

I agree with @SB2015 and @rebrascora about prebolus timings.

What was your daughters BG before breakfast? Your daughter has the Accu-Chek Aviva Expert if I remember correctly. This will take into account the insulin already on board when working out a correction or normal bolus

 

[Tom1982]

I agree with @SB2015 and @rebrascora about prebolus timings.

What was your daughters BG before breakfast? Your daughter has the Accu-Chek Aviva Expert if I remember correctly. This will take into account the insulin already on board when working out a correction or normal bolus

Nice one. Yes that’s right. Probably check her too much but on a few occasions we’ve checked after dinner and found her to be low (secretly feeding the dog her dinner will do that I suppose) but if we checked an hour after dinner and found she was 13.9 for example, would you correct then?

 

[Lily123]

I correct anything over 14 unless Libre says I am going up quickly in which case I correct before (double checking with the meter)

 

[Sally71]

Nice one. Yes that’s right. Probably check her too much but on a few occasions we’ve checked after dinner and found her to be low (secretly feeding the dog her dinner will do that I suppose) but if we checked an hour after dinner and found she was 13.9 for example, would you correct then?

I wouldn’t correct only an hour after eating because insulin is still working, and if the Accu Chek works how I remember it shouldn’t advise you to correct that early. After 2 hours maybe I’d correct but not the full amount. Otherwise you’re in danger of just bouncing from high to low and back again, and that’s worse for your body than being steadily high for a few hours. I think actually the fact that blood meters seem to advise corrections and ketone checks every time you get to 14 can be more confusing than helpful, if you’re only briefly above 14 but come down again because of insulin still in the system then you don’t need to be doing anything at all. Of course blood sugars are going to go up when you’ve eaten, just relax a bit and give them chance to come back down on their own, it’s impossible to get them perfect all the time no matter how hard you try and you can send yourself batty trying to get perfect numbers all the time. (I know, I’ve been there and done that.). Small periods of time above 14 are going to do no harm at all, it’s if it regularly sits there for hours at a time that you are lining yourself up for problems.

 

[trophywench]

..... and also please remember folks that what works fine for an adult will not always work the same - if indeed at all! - for a little child. I'm not at all certain that pre bolusing is ever recommended for kiddies.

 

[Tom1982]

I wouldn’t correct only an hour after eating because insulin is still working, and if the Accu Chek works how I remember it shouldn’t advise you to correct that early. After 2 hours maybe I’d correct but not the full amount. Otherwise you’re in danger of just bouncing from high to low and back again, and that’s worse for your body than being steadily high for a few hours. I think actually the fact that blood meters seem to advise corrections and ketone checks every time you get to 14 can be more confusing than helpful, if you’re only briefly above 14 but come down again because of insulin still in the system then you don’t need to be doing anything at all. Of course blood sugars are going to go up when you’ve eaten, just relax a bit and give them chance to come back down on their own, it’s impossible to get them perfect all the time no matter how hard you try and you can send yourself batty trying to get perfect numbers all the time. (I know, I’ve been there and done that.). Small periods of time above 14 are going to do no harm at all, it’s if it regularly sits there for hours at a time that you are lining yourself up for problems.

Very reassuring thank you. Need to calm down a bit. Easier said than done though.

 

[Sally71]

Very reassuring thank you. Need to calm down a bit. Easier said than done though.

Definitely not easy, especially when it’s your little one. It can be done though. Another brill piece of advice from our DSN was that there’s no point having perfect BGs all the time if that’s all you think about, you have to enjoy life too. And she’s so right, that helped me a lot. Just learn to enjoy watching your child play for a while instead of worrying about what her numbers are all the time. Trying to find the right balance between being too slack and not caring or micromanaging it to such a degree that you and your daughter are sick of it, is one of the hardest things. Took me quite a while but I got there in the end!